Biomedical subjects
Publications and source records attributed to C Fontolliet.
This paper presents the results of the first 7 orthotopic liver transplants performed in Lausanne between December 1988 and September 1990. 6 patients are surviving; their rehabilitation is excellent.
The etiology of esophagus papilloma is much debated: some authors attach greater importance to irritation factors, while others give preference to the viral hypothesis and suggest that this disease could eventually lead to squamous cell carcinoma of the esophagus. To verify the viral hypothesis, we reviewed the histological slides of the 33 cases of esophageal papilloma diagnosed in our Institute of Pathology between 1973 and 1988. We evaluated the histological diagnosis using Winckler's criteria. HPV typing was done using probes of HPV DNA types 6-11, 16-18, 31-33-35 applied to paraffin sections according to the in-situ hybridization method. Clinical and endoscopic data of 15 cases (from the CHUV) are reviewed. Oncological data was provided by the Vaud Cantonal Tumor Register. No patient in our series fulfilled all the histological criteria set by Winckler to diagnose an HPV condition. Viral DNA 31-33-35 was found in a small minority of the papillomas. The clinical impact of esophageal papilloma on epidermoid carcinogenesis is nil.
The authors describe the case of a seventy-four year old female with no past medical history, in whom a duodenal angiosarcoma was found during investigation for anemia. Despite adequate surgical excision, hemorrhage persisted and the patient died. Autopsy disclosed multiple angiosarcomatous tumours in the colon and pulmonary micrometastases. Angiosarcoma is a rare tumour in the digestive tract. Multiple tumors occur but are often difficult to detect. In the present case, radiologican and angiographic investigations did not confirm the diagnosis, which was made on endoscopic and surgical findings and substantiated by histological examination of the surgical specimen.
Regression and disappearance of Barrett's esophagus are a rare event of which there are only three well documented cases in the literature. Two cases are described in this study.
Two histological classifications of Barrett's esophagus are posited in the literature: (1) a layered disposition (Paull); (2) a mosaic pattern (Thompson). Only specialized epithelia are potentially neoplastic. Our experience, based on two histological studies, confirms the heterogeneity of Barrett's esophagus. These studies show that the mosaic pattern is more frequent than the layered disposition. Therefore we consider it extremely important to perform multiple biopsies (centimeter by centimeter on the four faces of the esophagus) to allow histological diagnosis of the specialized form of columnar epithelium and/or of dysplasia.
Prevalence and incidence of drug-related esophagitis are probably underestimated. The condition can often be diagnosed on the basis of history alone. Tetracyclines and emepronium bromide were implicated in most published cases. Endoscopy usually shows erosions in the upper two thirds of the esophagus. These esophageal lesions generally heal after the medication has been stopped. Complications such as stricture, hemorrhage or perforation are very rare.
We report the case of a patient who developed herpes simplex oesophagitis less than one month after renal transplantation. Graft rejection treatment may have induced this infection. Diagnosis was suspected at endoscopy and was confirmed by biopsy. The patient was cured by intravenous acyclovir and temporary discontinuation of immunosuppressive medication.
This prospective study involving 24 patients operated for postoperative reflux gastritis spanned over the period between 1974 and 1987. Diagnosis by exclusion was based on clinical, endoscopic and histological findings collected a few months to 16 years following surgery, the outcome of which was either alteration or destruction of the antropyloric sphincteral mechanism. All patients had Y-loop gastrojejunostomy performed according to Roux's procedure (at 50 cm). The clinical results as assessed on the basis of Visick's score and by gastroscopy were good. Anatomopathological examination of pre- and postoperative bioptic specimens blind-collected by a single operator indicated that foveolar hyperplasia is a good indicator of enterogastric reflux.
Barrett's ulcer is thought to develop in the columnar epithelium of Barrett's esophagus. In our series there is evidence that at least some Barrett's ulcers develop in squamous epithelium which may correspond to islets within Barrett's esophagus; in other cases Barrett's mucosa may surround a preexisting reflux-induced ulcer and thus transform it into Barrett's ulcer. In some individual cases of Barrett's ulcer development of the ulcer primarily in the columnar epithelium could not be ruled out. These ulcers may be produced by local acid secretion, by acid or alkaline gastroesophageal reflux in patients with reduced resistance of the columnar epithelium. Exceptionally, Barrett's ulcer may result from local irritation by medication (pill-induced ulcer) or by nasogastric intubation.
In 2 patients the finding of anti-Ro antibodies led to the diagnosis of Sjögren syndrome, which explained a succession of various autoimmune diseases, viz. glomerulonephritis, orbital lymphoma and hemolytic anemia in case 1; primary biliary cirrhosis, subacute cutaneous lupus erythematosus and subclinical autoimmune thyroiditis in case 2.
One hundred and ten patients with Barrett's esophagus were operated on between 1963 and 1986. Preoperative endoscopy showed active peptic disease in 94% of the cases and a stenosis or ulcer in 61%. An anti-reflux operation was performed in 102 cases and a resection in 8 cases. Operative mortality was 3.6% and the morbidity was 9%. After an average follow-up of 6.9 years, 83% of the patients were satisfied with their operation. Postoperative endoscopy was performed in 39 patients after an average of 5.4 years. No progression or regression of the columnar epithelium was found. Two patients developed an adenocarcinoma in spite of adequate reflux control.
Savary's ulcer is a rare and little known peptic ulcer situated just above Barrett's esophagus. It is predominant in elderly women, bleeds less than Barrett's ulcer and is almost always associated with peptic stenosis. It is, like Barrett's and Wolf's ulcers, a complication of gastroesophageal reflux and not of Barrett's esophagus.
The criteria for the use of liver biopsy as a diagnostic tool were retrospectively analyzed over a ten-year period in 390 consecutive patients. The four principal conditions in which this procedure was employed were alcoholism (33%), hepatitis (18%), abnormal hepatic tests (16%) and tumors (10%). The development of new, "non-invasive", investigative methods such as echography and tomodensitometry has led to an decrease in the number of liver biopsies performed annually, but no change in the relative frequency of the various indications. In this paper, evidence is presented which demonstrates that hepatic biopsy confirmed the clinical diagnosis in 62.4% of the cases reviewed and fundamentally modified the diagnosis in 20.2%. Based upon these findings, it can be concluded that liver biopsy remains an indispensable diagnostic procedure in the field of hepatology, since it can result in modification of the clinician's diagnosis in one out of five cases.
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Very commonly encountered in the United States, histoplasmosis is rare in Europe, where only 27 patients have so far been infected by this mycosis. In Africa, two varieties of histoplasmosis have been observed: those due to H. capsulatum and H. duboisii. Histoplasmosis due to H. capsulatum is one of the twelve secondary infectious diseases listed in the surveillance definitions of AIDS. This complication has been described only in approximately 20 patients with AIDS; all patients had stayed on the American Continents. We report the case of a 30-year-old African male who lived in Switzerland and in Zaïre. With AIDS and multiple Kaposi's sarcoma, the patient died from disseminated histoplasmosis due to H. capsulatum; a peripheral blood smear obtained a few hours before death revealed numerous typical yeast forms of H. capsulatum inside polymorphonuclear leukocytes. Post-mortem examination and cultures confirmed the diagnosis of disseminated histoplasmosis. Histoplasmosis should be suspected in AIDS patients even in Europe, especially where they have stayed in endemic areas. Examination of blood smears and bonemarrow aspirate may allow early recognition of the disease and permit appropriate treatment with amphotericin B and ketoconazole.
Treatment of periampullar carcinoma is known to be more rewarding than that of the cancer of pancreas. Operative mortality however remains high, and five-year survivors are a minority. Diagnosis of precancerous lesions should improve the prevention of these tumours. We review our ten-year experience, in which 16 periampullary carcinomas were operated on in patients aged between 45 and 90 years (average 69). 10 Whipple and 3 local resections, and 3 by-pass procedures were performed. Two patients died during the first two postoperative weeks, after a Whipple and a by-pass procedure respectively. Survival after the Whipple operations averaged 35 months (3 patients are still alive up to 60 months later) and 9.9 months after the other procedures. All the histologic specimens were reviewed for lesions such as adenomatous polyps or epithelial dysplasias coexisting with carcinoma. We found such associations in 3 biopsies or local excisions and in 4 pancreaticoduodenal resections. These findings confirm that periampullar carcinoma is preceded in a significant number of cases by pre-malignant conditions. It is hoped that awareness of this fact will make possible early diagnosis and treatment.
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An ultrastructural study was performed on 34 biopsy samples of the sinusal mucosa in 28 patients who were investigated for chronic sinusitis. Twelve specimens with normoplastic sinusitis and eighteen with hyperplastic sinusitis were studied. Four normal specimens served as controls. The incidence of ultrastructural ciliary abnormalities was 2%. Morphological changes of dynein arms have not been observed in the present study. Compound cilia were found in approximately 2/3 of the studied cases. Microtubular abnormalities occurred in roughly 50%. The observed abnormalities, also seen in the control group, were independent on the sinusitis type and could not been correlated with mucociliary transport. Their significance is discussed.